Failure to Honor Resident Representative’s Request for Hospital Evaluation
Penalty
Summary
The facility failed to honor a resident and responsible party's right to make informed decisions regarding treatment when a request for hospital evaluation was not followed. Facility policy on residents' rights and advanced directives stated that residents have the right to request, refuse, and/or discontinue medical or surgical treatment. The resident involved was cognitively impaired, required staff assistance for daily care, had cirrhosis of the liver, was receiving hospice services, and had a PleurX catheter with a care plan directing nursing staff to monitor the dressing and observe for signs of infection or worsening condition. A nurse's note documented that the resident's wife, acting as responsible party, requested that the resident be sent to the emergency room due to continued leaking from the liver catheter and asked to speak with the provider. The nurse contacted the CRNP with an assessment, and the CRNP consulted with the hospice nurse. They agreed the resident did not need to go to the emergency room and that the hospice nurse could assess the resident at the facility. When informed of this, the resident's wife insisted on taking her husband to the emergency room and verbally rejected hospice and the facility's position. Staff told her she had the right to go to the emergency room but could not provide an order for transfer and that leaving would be against medical advice because the provider wanted the resident to remain for hospice assessment. An interview with the Regional RN confirmed that if the responsible party requested hospital evaluation, the resident should have been sent, indicating that the facility did not honor the responsible party's request for transfer for evaluation.
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